Next Article in Journal
Preventive Medicine for Person, Place, and Planet: Revisiting the Concept of High-Level Wellness in the Planetary Health Paradigm
Previous Article in Journal
Dissipation Dynamics and Residue of Four Herbicides in Paddy Fields Using HPLC-MS/MS and GC-MS
Article Menu
Issue 2 (January-2) cover image

Export Article

Open AccessArticle

Heart Rate Variability and Performance of Commercial Airline Pilots during Flight Simulations

Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA
Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(2), 237;
Received: 3 December 2018 / Revised: 8 January 2019 / Accepted: 11 January 2019 / Published: 16 January 2019
PDF [1587 KB, uploaded 16 January 2019]


Pilots undergo a variety of stressors that may affect their performance during all phases of flight. Heart rate variability (HRV) has been considered as a reliable indicator of the parasympathetic and sympathetic activities of human autonomic nervous system, which can be used to characterize the sympathetic stress response of pilots during flight. In this study, thirty active commercial airline pilots were recruited to fly three flight segments in a Federal Aviation Administration (FAA)-certified A320 flight simulator with each segment at a different carbon dioxide (CO2) concentration on the flight deck. The pilots performed a series of maneuvers of varying difficulty, and their performance was evaluated by FAA designated pilot examiners. The HRV metrics (SDNN, RMSSD and LF/HF ratio) of each pilot both before and during flight simulations were measured with a Movisens EcgMove3 sensor. The average SDNN, RMSSD and LF/HF ratio of the pilots during flight simulations were 34.1 ± 12.7 ms, 23.8 ± 10.2 ms and 5.7 ± 2.8 respectively. Decreased HRV was associated with aging, obesity and performing difficult maneuvers. Both CO2 exposure and HRV had an independent effect on the pilot performance, while their interaction was not significant. The generalized additive mixed effect model results showed that a pilot performed better on a maneuver when his stress response was lower, as indicated by higher SDNN and RMSSD and lower LF/HF ratio. An interquartile range (IQR) increase in SDNN (21.97 ms) and RMSSD (16.00 ms) and an IQR decrease in LF/HF ratio (4.69) was associated with an increase in the odds of passing a maneuver by 37%, 22% and 20%, respectively. View Full-Text
Keywords: heart rate variability; pilot; carbon dioxide; stress; flight maneuver heart rate variability; pilot; carbon dioxide; stress; flight maneuver

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

Supplementary material


Share & Cite This Article

MDPI and ACS Style

Cao, X.; MacNaughton, P.; Cadet, L.R.; Cedeno-Laurent, J.G.; Flanigan, S.; Vallarino, J.; Donnelly-McLay, D.; Christiani, D.C.; Spengler, J.D.; Allen, J.G. Heart Rate Variability and Performance of Commercial Airline Pilots during Flight Simulations. Int. J. Environ. Res. Public Health 2019, 16, 237.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics



[Return to top]
Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top